HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \ \"1�\� SCANNED Permit Number:
BY
o St. Lucie County Building Permit Applicati[ n RD
APRs 7 , ECEIVE
Planning and Development Services
Building and Code Regulation Division ST. 019
Lucie County, Permit
2300 Virginia Avenue, Fort Pierce FL 34982 —
Phone: (772)462-1553 Fax: (772) 462-1578 Commercial X Residential V�
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:` "
Address: WOU �ntlno Ro it�t� fclifi l�ielce,FL 34�151 \�
Property Tax ID #: 11 j a i- 0 O I5 - 0 (70y Lot No. 0
Site Plan Name: I dl ra n P i u sy i 11 4 e Block No. i
Project Name: (1111 t�C�h Cw ly\
'DETAILED DESCRIPTION OF WORK;
t
CONSTRUCTIQN:INF.ORMAT,ION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping —Shutters
—Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: CC Sq. Ft. of First Floor:
Cost of Construction:$ lb(Q l (j Utilities: _Sewer _Septic
lWindows/Doors
Roof Pitch
Building Height:
-OWNER LESSEE'_.CONTRACTOR
NametAkCnrIj�l a (0,t%eev\
Nam6jQCY)CL6 Mtllh
Address:lQOOW �Y bf k o Po '1
Company: Cali l{' d AlU('( wmi'M : 1111tr MU).i
city: FCi� u6-Ci. State: fL
Zip Code: � Li qC3 I Fax:
Phone No. ) 1 d" ��al- lgJl
Address:130-F COlmMUCC UkAtf-Y VIL
City: ;7f' W0 `i -1 a \ State:-fL--
Zip Code: fDaa58 Fax:"l la 203 Eq?iq
Phone No Ti a M lk 1 tv (, C`
E-Mail: C�T1C
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail QYW CIO 11
t)J
TnCi1:P_klr(-i0_i I . (f) n/1
State or County License C 10 a I•('� j tj
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requirea.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
'r ,
SUPPLEMENTACCONST,RUCTION LIENIAW INFORMATION'=- w_ .
U GbR3 N t:K1 LNUlNt:tK: _ Not Hpplicame MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Address:
City:
Zip: Phone:
BONDING COMPANY:
Address:
Zip:
_Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Ignature of Owner/ Lessee/Contractor as Agentfor Owner
S a ru a o�ractot/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �, ( "e.a-'
COUNTY Op—/FEnrl J,
The forg�. instr ment wa acknowledged before me
The forg�lu�}nstrum n was acknowledged before me
this Ray"Ir•l'� .20by
thi/5 d' A`yof�nn�., .201_9by
c_Q )`/a �OO�n g� jvc1afi�.Nw 7
M'eJ'Ae1
Name of person making statement.
Name of person making state
Personally Known R Produced Identification
Personally Known OR Produced Identification
Type of Id- ; fication
Type of Ident cation
Produce �^
Produced
Ignature of Notary Public- State of Florida
Jgignature of Notary Public- State of Florida )
r� �F'"0 SHERI t. COCK
Commission No. t,�� `9 y"� �' 'Q`"e • c
1 �l�'COfAMISJGNkFF994
1
! �j� �ISHERI L. COGK
ommission No. rroar eal) it FF B44S
* 'le E%FIRES: June 22, 2020
e°��""• try COMMISSION
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- F�(PIRES:JurIe22,2020
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DATE
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Rev.217119